IPT overview
Both interactions & expectations can affect our mood -> can we help ppl work out disputes w expectations surrounding depression?
* Focus is primarily on current interpersonal & romantic relationships
* Goal: alleviate symptoms (e.g., depression) by focusing on current relationship patterns & social support as a point of intervention; not trying to change personality features that have their origin in early childhood experiences.
Most medical model: takes on the term “patient”, also takes on a limited “sick role” which frames depression as smtg that’s real & debilitating but smtg you can heal from.
Social support & depression
- People w depression have less social support (lower marital satisfaction, confide less in partners, less contact w friends & extended family
- Bidirectional - lack of social support can be a risk factor for depression, & it may also be an effect of depression; “Vicious cycle” set up in maintaining the depression
- Treatment for depression must (at least in part) target the social context
the less social support you have the less you can reach out which can lead to depression, OR the more depression you are feeling, the less you might feel you can reach out to gain social support
history
- 1960s/70s: Gerald Klerman, M.D.,& Myrna Weissman, Ph.D., developed this treatment for depression specifically
○ Time-limited (12-16 sessions)
○ Theory-based & research-based- Prior work of Harry Stack Sullivan inspired IPT theory
○ Stressed social & interpersonal factors
○ Psychodynamic attachment theory - 1984: First manual published
- 1989: NIMH multi-site randomized controlled study
○ IPT, CBT, and antidepressant medication (imipramine) were all found to produce significant improvement in depressive symptoms - Current status: Strong research base
○ Applied to many age groups & clinical conditions
- Prior work of Harry Stack Sullivan inspired IPT theory
theoretical basis
- Based on a biopsychosocial diathesis model
○ genetic predisposition interacts w early life experiences (attachment style) & psychosocial stressors to produce mental health conditions- Those who have a secure attachment are able to feel safe & develop trust in others
- Insecure attachment results in maladaptive patterns of communication & interpersonal relationships
- Not a causal explanation for depression but a pragmatic treatment
○ Regardless of original cause, depression occurs in a social context
○ Incorporates behavioral techniques w psychodynamic attachment theory
specific components of IPT
- Target for treatment: distressing emotional symptoms (e.g., depression) resulting from psychodynamic mechanisms
- Emphasis: helping the client develop better strategies for dealing w current problematic relationships
- Aims to help patients in current relationships - evaluate their expectations & improve communication of their needs & emotions
- Not realistic to expect an attachment style from early childhood to be modified in a short-term treatment
therapist role
- Therapist works initially as a client advocate - help client procure housing, transportation, financial support
- Emphasize relationship-building qualities; e.g., nonjudgmental, warm, accepting, empathic
- Optimistic
- Active stance, educative, diagnostic
- Gentle confrontation
- Encourage problem-solving
- Therapist may make selective self-disclosures
○ Provide feedback to patient about communication style
○ Identify use of defense mechanisms
*might be having a covert role dispute - not brought up, & need to help client bring that to surface & gain awareness of their interpersonal issues
Stage I: Evaluation Phase - Initial sessions (1-3)
- Assess symptoms & give the syndrome a name
○ Explain depression as medical illness; give patient the “sick role” - “Clinical depression affects how you think, feel, & act.”- Inquire about client’s current interpersonal relationships & pattern of social functioning - “Who supports you? How can they help you out?”; “Who is not supportive? How do they bother you?”
- Explore links - relationship changes (including any losses) & onset or increase in depression
- Identify problem areas: one or two targeted
- Discuss IPT therapeutic process
- Develop contract - jointly agree on treatment goals, problem areas, fees, # of sessions, length of sessions
Therapist takes more of a doctor-patient stance, at least in initial sessions
Stage II. Intermediate Phase: Focus (Interpersonal areas associated w depression) Grief
e.g., prolonged (i.e., 6 months or longer), complicated bereavement - unfinished business of some kind (i.e., unexpressed emotions like resentment & anger)
○ Facilitate mourning
○ Explore positive & negative feelings
○ Replace aspects of what was lost & begin to move forward
○ E.g., Write a letter to the deceased or have a visit to the grave & conversation
Role Dispute
e.g., dispute w romantic partner
○ Non-reciprocal role expectations w partner
○ Identify dispute, what you want & do not want
○ Identify possible options and courses of action
Modify expectations or faulty communication
Role transitions
e.g., break-up, graduation, move, birth of child, loss of job, retirement
○ Mourn & accept loss of old role
Explore feelings about the loss & opportunities of new role
Interpersonal deficits
e.g., isolated, hypersensitive individuals
○ Reduce patient’s social isolation
○ Encourage new relationships
○ Plan activities outside of the therapy session
○ Can use role plays in-session to practice new skills
Stage II: Intervention Strategies
- Education regarding depression & reviewing symptoms
○ Identify hopelessness, sadness, & other symptoms as part of a syndrome - helps patients distance themselves from their illness- Encourage emotional expression - help client acknowledge, express, release, & accept painful feelings associated w current interpersonal relationships (can’t express it if you don’t first acknowledge it)
- Enhance interpersonal relationships
○ Communication analysis - patient provides highly-detailed account of interactions (“play-by-play”)
○ Behavioral techniques: e.g., modeling & role-playing - client taught to consider diff options & evaluate possible consequences of diff choices in dealing w problematic relationships or interactions
Self-reflection: communication analysis
- Think of a situation in which a comm. issue took place; it could be a relatively mild concern or a fictionalized account
○ At work, home, or school; W family, friends, room-mate or partner - friend made a joke when you’re in a bad mood that triggered me- Ask yourself these questions:
○ What did you do? - snapped at your friend for making the joke
○ What did the other person do? - snapped back at you & attributed it to you being “unfun”
○ What did you want the other person to do? - see that you weren’t in a good mood & be understanding (& maybe don’t make jokes)
○ What worked? - going to my room to cool off & apologizing later
○ What didn’t work? - getting mad & snapping at the joke & friend right away instead of communicating how I was feeling
What did you bring to the interaction (or the dispute)? - escalating a very harmless situation based on your mood & interpretation
- Ask yourself these questions:
Stage III: Termination phase
- Discuss feelings about end of treatment
○ Honest feedback
○ Acknowledge any feelings of sadness
○ Opportunity for a “good goodbye”- Review treatment progress
○ Re-assess depressive symptoms
○ Compare to pre-assessment
○ “Lessons learned” - Outline remaining work
○ Offer suggestions for relapse prevention - e.g., “How are you going to recognize if your depression comes back & what are you going to do?”
○ Consider monthly “booster” sessions for recurrent depression (“Maintenance Treatment”)
○ Make appropriate referrals
- Review treatment progress
Case Study: Cindy
- Pre-Treatment
○ Cindy’s husband took new job that required frequent travel - Cindy discovered she was pregnant w twins
○ Husband became more distant – Cindy developed major depression – Role Dispute identified as problem area linked to Cindy’s depression- IPT Treatment
○ Education
○ Identify dispute & what Cindy wants and does not want
○ Review diff options available
○ Communication Analysis
○ Role Play - Post-Treatment
○ Cindy became more open & connected w husband, expressing her needs more – no longer meets DSM-V criteria for Major Depression, & she joined a parent support group
○ Hamilton Depression Rating Scale = in the normal range
- IPT Treatment
IPT Evaluations & Applications
- In 2016, Cujpers et al published a helpful meta-analysis of 90 prior IPT studies for depression
○ IPT had mod to lg effect size compared w ctrl groups
○ IPT was just as efficacious as other therapies, including CBT & pharmacotherapy- IPT had significant effects in treating eating disorders as well. CBT appeared to be more effective than IPT for eating disorders in the acute phase (acts faster).
- IPT was also effective in treating some anxiety disorders. The size of the effect was comparable to CBT.
Strengths
- Builds on strengths of psychoanalytic theory & makes this approach more efficient
- Short-term treatment - present-oriented (“here & now” focus); active, targeted, goal-oriented, & provides symptom relief; pragmatic; cost-effective
- Strong commitment to research
- Empirically supported treatment - e.g., adult clinical depression; applied to many other age groups & clinical conditions (e.g., bulimia, social anxiety, adolescent depression, late-life depression)
- Manuals available for several clinical conditions
○ Easy to teach & learn
○ Good for new therapists - Adapted for some ethnic groups
Weaknesses
- Clients must have some minimal ability & need to:
○ Improve their interpersonal relationships
○ Explore their feelings- Short-term treatment
○ Is it just a superficial treatment?
○ Does it just target symptom-reduction?
○ Are treatment gains maintained over long-term?
○ How effective is it for chronic issues? - Is it simply a re-packaging of existing treatments – part psychodynamic theory & part behavioral strategies?
- Short-term treatment
Pres: Interpersonal Therapy for Adolescents with Depression
34% of adolescents globally are at risk of developing clinical depression. IPT-A involves roughly 12-16 sessions, a limited sick role, closeness circle, & balancing parental involvement w adolescent privacy. IPT & CBT are both first-line treatments for adolescent depression.
Pres: Interpersonal Therapy for Older Adults with Depression
Older adults who are depressed are more likely than younger adults to express somatic symptoms of subjective cognitive constraints. Effectiveness is comparable in using IPT, CBT, and pharmacotherapy. Research is emerging in other countries such as Russia, China, & India.
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Chapter 1: Psychotherapy & Counseling Essentials41
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Chapter 2: Psychoanalytic Approaches55
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Chapter 5: Person-Centered Theory & Therapy44
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Chapter 4: Existential Theory & Therapy47
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Cognitive Behavioural Therapy20
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Interpersonal Therapy20
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Motivational Enhancement Therapy16
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Chapter 13: Multicultural Orientation and Skills21
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Pharmacotherapy & Psychotherapy26
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Future Directions & Integration12
